Review and Feature Article
Eosinophilic Pneumonias

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The eosinophilic pneumonias are a heterogeneous group of diseases characterized by an increase in eosinophils in lung tissue or bronchoalveolar lavage fluid. Many, but not all, of the eosinophilic pneumonias are also associated with a peripheral blood eosinophilia. The etiologies of eosinophilic lung disease are wide ranging and include parasitic infections, medications or other toxins, autoimmune and inflammatory disease, and malignancies. Some eosinophilic pneumonias have no proven cause or inciting event and are classified as idiopathic. An accurate diagnosis can prove difficult and often relies on a combination of a thorough history and physical examination, including travel and medication history, laboratory and radiographic evaluation, and, in some instances, bronchoscopic and histologic evaluation. Early and accurate diagnosis is imperative in certain diseases, such as acute eosinophilic pneumonia, as delayed diagnosis and treatment can lead to fatal lung disease. Corticosteroids are the mainstay of treatment for many of the eosinophilic pneumonias, particularly for both acute and chronic eosinophilic pneumonias, and prognosis is typically excellent provided treatment is initiated in a timely manner.

Section snippets

Infections

Among infectious etiologies of pulmonary eosinophilia, parasitic disease has historically had the strongest association with eosinophilic pneumonias. In the Western world, the most common parasitic causes of eosinophilic lung disease include Ascaris, Ancylostoma, Toxocara, and Strongyloides infection, whereas in India and Southeast Asia, microfilaria-induced tropical pulmonary eosinophilia is more common.1

Drug-induced Pulmonary Eosinophilia

Drug-associated eosinophilic pneumonia can have wide-ranging clinical manifestations. Patients may have asymptomatic pulmonary eosinophilia, chronic cough or shortness of breath, or acute and rapidly progressive hypoxia. A thorough medication history is paramount for all patients with evidence of either pulmonary or peripheral blood eosinophilia. Nonsteroidal anti-inflammatory drugs (NSAIDs) and antimicrobials are most commonly associated with eosinophilic pneumonia.9, 10, 11 Among the

Acute Eosinophilic Pneumonia

Acute eosinophilic pneumonia (AEP) is a severe, rapidly progressive lung disease that, if not recognized or treated, can result in fatal respiratory failure. The precise pathogenesis and etiology of AEP is still unknown, but there is some correlation between AEP and preceding exposure to inhalational agents, such as cigarette smoke. The diagnosis of AEP is dependent on maintaining a high index of clinical suspicion as well as characteristic findings in BAL fluid. Although the disease can

Chronic Eosinophilic Pneumonia

In contrast to AEP, CEP is an insidious disease with an average symptom duration of 7 to 8 months before clinical diagnosis is made. CEP should be suspected in patients experiencing several months of progressive shortness of breath with radiographic evidence of bilateral peripherally located opacities. In addition, it is associated with a peripheral blood eosinophilia. CEP is a rare disease with an estimated incidence of 0.23 cases/100,000 population between the years 1990 and 2014.37 Early

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    Conflicts of interest: The authors declare that they have no relevant conflicts of interest.

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